Saturday, May 6, 2017

Do Gastroenterologists Make Only $50 Per Hour?

Really?

We recently had visiting medical students rotate through our hospital. As their final exit projects, they made presentations about what fields they find interesting and are thinking about entering. One student assembled a beautiful poster board of his favorite medical specialty. He chose gastroenterology.

Among all the detailed descriptions of the duties of GI docs, there was this one little panel down near the bottom. As you can see, he stated that they make roughly $200,000-$400,000 per year. Sounds a little low but okay. But then there was the kicker. This salary comes out to roughly $50 per hour. What?

All the gastroenterologists who saw this were aghast. Could that be right? Were they making only $50 per hour? After multiple decades of education and training, hundreds of thousands of dollars in student loan debt, tens of thousands of dollars in malpractice insurance payments each year, countless hours of lost sleep and family time, were they earning just $50 each hour? How can GI docs, always ranked near the top of physicians with the highest compensation, be making so little?

When they did a quick back of the envelope calculation, they were dismayed to realize he was right, up to a point. First of all, let's assume that the student meant that $50 is after tax income. The alternative is just too horrible to contemplate. Therefore, the doctor is making roughly $100/hr before taxes in a high tax state like here in California. Thus the gastroenterologist who makes $200,000 each year is putting in roughly 2,000 hours per year. This is the same number of hours as Joe Schmoe who works 9 to 5, 40 hours per week, 50 weeks per year.

But we know that doctors don't work 9 to 5 jobs. They are at the hospital by 6:00 or 7:00 AM, rounding and doing procedures, going to their offices and seeing patients, and may not get home until twelve or thirteen hours later. And don't forget about calls and weekends and middle of the night phone calls from nurses. According to Medscape's physician survey, gastroenterologists typically spend 30-55 hours each week seeing patients. Then there is the paperwork and office administration. More than half in the poll said they spent more then ten hours each week dealing with this headache.

So now we're up to around 60 hours per week of work. Calculate that into the $200,000 with 50 weeks of work each year and we're down to $67 per hour PRE tax income. After tax that comes to less than $40 per hour. How depressing is that?

But GI doctors don't make that little amount right? Aren't they more likely to make the upper range of incomes listed on the poster? When I asked our gastroenterologists, I was surprised that it is quite common to make $200,000 per year, or LESS in GI. Mostly this affects the doctors that are working in academia. Among high profile medical institutions, the compensation granted to GI doctors is typically less than $200k. The prestige of being named an Associate Professor of Gastroenterology at High Falutin Medical Center allows these hospitals to pay their physicians much less than the private world. In return, they can list on their C.V.'s their academic prowess and hopefully get more lucrative job offers and speaking fees in the future.

But if one wants to bust their balls or ovaries in private practice, they can certainly make $400k or more. They're just gonna have to rack up their hours and make sure they are at the beck and call of the emergency department and the hospitalists. They will be expected to come to the hospital and scope a patient at any time, 24/7. If they start refusing cases because the hours are inconvenient, then the consults dry up and so do their incomes.